Module 1: What is COVID-19?

A new virus called the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified as the cause of a disease outbreak that began in China in 2019. The disease is called coronavirus disease 2019 (COVID-19).

In March 2020, the World Health Organization (WHO) declared COVID-19 a pandemic.

COVID-19 symptoms can be very mild to severe and include a fever, cough and shortness of breath. Some people have no symptoms. Symptoms may appear two to 14 days after exposure.

https://www.mayoclinic.org/diseases-conditions/coronavirus/expert-answers/novel-coronavirus/faq-20478727

Coronaviruses - what are they?

Coronaviruses are a large family of viruses that usually cause mild to moderate upper-respiratory tract illnesses, like the common cold. However, three new coronaviruses have emerged from animal reservoirs over the past two decades to cause serious and widespread illness and death.

There are hundreds of coronaviruses, most of which circulate among such animals as pigs, camels, bats and cats. Sometimes those viruses jump to humans-called a spillover event-and can cause disease. Four of the seven known coronaviruses that sicken people cause only mild to moderate disease. Three can cause more serious, even fatal, disease. SARS coronavirus (SARS-CoV) emerged in November 2002 and caused severe acute respiratory syndrome (SARS). That virus disappeared by 2004. Middle East respiratory syndrome (MERS) is caused by the MERS coronavirus (MERS-CoV). Transmitted from an animal reservoir in camels, MERS was identified in September 2012 and continues to cause sporadic and localized outbreaks. The third novel coronavirus to emerge in this century is called SARS-CoV-2. It causes coronavirus disease 2019 (COVID-19), which emerged from China in December 2019 and was declared a global pandemic by the World Health Organization on March 11, 2020.

https://www.niaid.nih.gov/diseases-conditions/coronaviruses

Module 2: How to stay safe on the job

Patients with COVID 19 Have Mild to Moderate Respiratory Symptoms

• Data suggests that symptoms may appear in as few as 2 days or as long as 14 days after exposure to the virus that causes COVID-19.
• Symptoms can include fever, cough, difficulty breathing, and shortness of breath.
• The virus causing COVID-19 is called SARS-CoV-2. It is thought to spread mainly from person-to-person via respiratory droplets among close contacts. Respiratory droplets are produced when an infected person coughs, sneezes, or talks and can land in the mouths or noses, or possibly be inhaled into the lungs, of people who are nearby. Close contact may include:
  • Being within approximately 6 feet of an individual with COVID-19 for a prolonged period of time.
  • Having direct contact with body fluids (such as blood, phlegm, and respiratory droplets) from an individual with COVID-19.
• Recent studies indicate that people who are infected but do not have symptoms likely also play a role in the spread of COVID-19.

To Protect Yourself from Exposure

• If possible, maintain a distance of at least 6 feet.
• Practice proper hand hygiene. Wash your hands with soap and water for at least 20 seconds. If soap and water are not readily available and illicit drugs are NOT suspected to be present, use an alcohol-based hand sanitizer with at least 60% alcohol.
• Do not touch your face with unwashed hands.
• Have a trained Emergency Medical Service/ Emergency Medical Technician (EMS/EMT) assess and transport anyone you think might have COVID-19 to a healthcare facility.
• Ensure only trained personnel wearing appropriate personal protective equipment (PPE) have contact with individuals who have or may have COVID-19.
• Learn your employer's plan for exposure control and participate in all-hands training on the use of PPE for respiratory protection, if available.

Recommended Personal Protective Equipment (PPE)

Law enforcement who must make contact with individuals confirmed or suspected to have COVID-19 should follow CDC's Interim Guidance for EMS. Different styles of PPE may be necessary to perform operational duties. These alternative styles (i.e. coveralls) must provide protection that is at least as great as that provided by the minimum amount of PPE recommended.

The minimum PPE recommended is:

• A single pair of disposable examination gloves,
• Disposable isolation gown or single-use/disposable coveralls*,
• Any NIOSH-approved particulate respirator (i.e., N-95 or higher-level respirator); Facemasks are an acceptable alternative until the supply chain is restored, and
• Eye protection (i.e., goggles or disposable face shield that fully covers the front and sides of the face)

*If unable to wear a disposable gown or coveralls because it limits access to duty belt and gear, ensure duty belt and gear are disinfected after contact with individual.

• Clean and disinfect duty belt and gear prior to reuse using a household cleaning spray or wipe, according to the product label.
• Follow standard operating procedures for the containment and disposal of used PPE.
• Follow standard operating procedures for containing and laundering clothes. Avoid shaking the clothes.

https://www.cdc.gov/coronavirus/2019-ncov/community/guidance-law-enforcement.html April 09, 2020

How to use PPE

Donning a mask: https://www.youtube.com/watch?v=OABvzu9e-hw

Gloves: https://www.youtube.com/watch?v=xueBYfElFEg

Module 3: Response Protocols - Keeping Responders Safe

Response Protocols

Listed below are three pandemic response protocols. Your department may wish to adopt any or all of these procedures.

Recommendations from VERA.org

Prioritize prevention first and foremost. To reduce contact between people, law enforcement can:

1. Equip 911 call-takers and dispatchers to divert more calls-for-service to health resources when they do not require police response.

2. Issue a temporary directive to release people on a citation, ticket, or summons in lieu of taking them into custody, unless the person poses an immediate and identifiable risk to physical safety or is charged with a serious felony.

3. Suspend standard protocols that place people in custody by, for example:
   1. suspending enforcement of bench warrants;
   2. limiting enforcement of arrest warrants to violent crimes; and/or
   3. documenting, but declining to take into custody, people who have violated probation and parole if they do not pose an immediate and identifiable risk to physical safety.

4. Limit their response to low-risk incidents in order to maintain capacity to respond to critical incidents and community health needs. For example, suspend enforcement of most traffic stops, noise complaints, minor quality-of-life complaints, and the service of civil subpoenas.

5. Limit the number of officers who have contact with visitors to the police department, preferably to one officer per shift and equip that officer with the personal protective equipment and training necessary to prevent the spread of the virus.

6. Deploy or expand online reporting options for complaints or police reports. Encourage an expanded range of incident reporting by phone.

7. Increase the frequency of cleaning and disinfecting of all patrol cars, police precincts, and station houses, with special attention to high-traffic areas.

Contain the possibility of spread. To protect especially people who are at high risk-those who are 55 years and older, pregnant, or have serious chronic medical conditions-law enforcement can:

1. Use a CDC-informed screening tool for anyone who is brought to or from a police station with the aim of identifying people with possible exposure and people at higher risk of infection.

2. Develop a written policy and training for law enforcement staff to separate people who are symptomatic from others, and to maximize the distance between people at higher risk of infection from people who may be infected but asymptomatic. The protocol should include guidance on how to work with other first responders to safely transport someone to the hospital, identify hospitals closest to the precinct or station house, and outline steps to take during and after interactions with an infected person.

https://www.vera.org/downloads/publications/coronavirus-guidance-police-law-enforcement.pdf

The CDC COVID 19 Self Check is available here: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/testing.html

Pennsylvania State Police Statement 04/01/2020

"To enhance social distancing and keep our personnel and the public safe and healthy, we will begin collecting information via telephone for incidents that do not require an in-person response from a trooper," said Colonel Evanchick. "This change affects only a limited number of call types, and the public can be confident that the PSP has the personnel, equipment, and plans in place to respond to emergencies and other critical incidents."

Call types eligible for a modified response include lost and found items, littering, identity theft, and general requests to speak to a trooper. While limiting in-person contact and collecting as much information via telephone is the goal, the actual response will be based on the totality of the circumstances of each unique situation in consultation with a supervisor on duty. State police response protocol to emergencies and crimes in progress remains unchanged.

The department asks the public to be mindful of social distancing if they need to visit their local PSP station. Signs have been posted at each entrance instructing visitors not to enter the facility if they are experiencing symptoms or have been in close contact with someone who has tested positive for COVID-19. Instead, they are instructed to contact the station by phone to speak to a trooper who may come outside to resolve the situation one-on-one if needed.

Philadelphia Police Department Response Protocols

PHILADELPHIA POLICE DEPARTMENT

FROM THE POLICE COMMISSIONER DANIELLE M. OUTLAW

Police Radio and Responding Officers will adhere to the following protocols when handling potential Covid-19 symptoms:

Philadelphia Police Department Covid-19 - Officer Safety Protocols and Coordinated Police Radio/ Patrol Response Protocols.

1. Police Radio

1. Call takers will begin health-related questioning for all calls regarding persons at the location where officers will be dispatched.

2. If a caller self-identifies themselves or any other persons on location as positive for Covid-19 or sick with flu-like symptoms (fever, coughing and sneezing, etc.):

1. Advise the caller that responding officers will be wearing masks and protective gloves upon arrival;

2. Notify responding officers that persons on location are positive for Covid-19 or are exhibiting flu-like symptoms; and

3. A Radio supervisor will be immediately notified of all locations where a caller has indicated that any person at the location tested positive for Covid-19. The Radio Supervisor will immediately create a premise history for this location.

2. Responding Officers:

3. Level 1 - Safety Procedure (no Covid-19 or flu-like symptoms have been identified by Police Radio). Officers shall:

4. Attempt to maintain a safe distance of at least six (6) feet from any complainant;

5. Assess whether the complainant appears sick with any cold or flu-like symptoms. If so, notify the complainant that you will return shortly, leave the location, and put on your protective mask, protective gloves and glasses if available. (i.e. Level - 2 Safety Procedure);

6. Re-engage the complainant and handle the assignment;

7. If any officer is coughed, sneezed, or spit upon while engaging with any person, submit a report to the Infectious Control Officer;

NOTE: The Infections Control Officer will determine whether quarantine is necessary; After every assignment use hand sanitizer or seek a location with soap and water and wash hands before resuming from the assignment; and

8. This policy shall not prohibit an officer from using a mask and protective gloves if they believe it is necessary.

4. Level 2 - Safety Procedure (when notified by Radio of a positive Covid-19 patient on location, or (2) persons with flu-like symptoms are on location). Officers shall:

1. Prior to arriving on location, put on your protective mask, protective gloves and eyeglasses if available;

2. Attempt to maintain a safe distance of at least six (6) feet from any complainant;

3. Advise all complainants that you are required by policy to remain six feet away from the complainant during the health crisis;

4. If any officer is coughed, sneezed or spit upon while engaging any person while wearing a mask or protective gloves, at the conclusion of the incident submit report to the Infectious Control Officer;

NOTE: The Infections Control Officer will determine whether quarantine is necessary.

5. While it may be difficult, prior to responding to any incident where an arrest or 302 contact is possible, officers should put on their mask and protective gloves. Take the time to protect yourself first; and

6. After every assignment, use hand sanitizer or seek a location with soap and water and wash hands before resuming from that assignment.

5. Level 3 - Safety Procedure Safety Procedure (when notified by Radio of a positive Covid-19 patient on location, or two (2) persons with flu-like symptom are on location AND OFFICERS OBSERVE ANY PERSONS ON LOCATION ACTIVELY COUGHING OR SNEEZING, Officers shall:

1. Barring exigent circumstance, withdrawal from the location and notify Police Radio to activate a MIRT Team to the location;
2. Stay on location outside the location and advise the complainant that police are responding with higher-level safety equipment; and
3. Await arrival for MIRT Officers to interact with the complainant and provide necessary information. Responding Officers will still be responsible for handling and reporting the overall assignment.

http://phillypolice.com/news/covid-protocols/d/2PACX-1vThbtGXEaJuk7q3LLtD4yfDzg5bDBt0duhdeHU_WR5dTAazFcJY55A6FTV-wrgCMezgVLiG3z68bhlJ/index.html

Dispatch

The Health Insurance Portability and Accountability Act (HIPAA) does not bar the disclosure to law enforcement of the location and/or identity of COVID active individuals. Several states (not Pennsylvania) are actively advising officers regarding the COVID status of potential contacts.

U.S. Department of Health and Human Services directive: https://www.hhs.gov/sites/default/files/covid-19-hipaa-and-first-responders-508.pdf

• When first responders may be at risk of infection. A covered entity may disclose PHI to a first responder who may have been exposed to COVID-19, or may otherwise be at risk of contracting or spreading COVID-19, if the covered entity is authorized by law, such as state law, to notify persons as necessary in the conduct of a public health intervention or investigation. For example, HIPAA permits a covered county health department, in accordance with a state law, to disclose PHI to a police officer or other person who may come into contact with a person who tested positive for COVID-19, for purposes of preventing or controlling the spread of COVID-19. 45 CFR 164.512(b)(1)(iv).

• When the disclosure of PHI to first responders is necessary to prevent or lessen a serious and imminent threat to the health and safety of a person or the public. A covered entity may disclose PHI to prevent or lessen a serious and imminent threat to a person or the public, when such disclosure is made to someone they believe can prevent or lessen the threat, which may include the target of the threat. For example, HIPAA permits a covered entity, consistent with applicable law and standards of ethical conduct, to disclose PHI about individuals who have tested positive for COVID-19 to fire department personnel, child welfare workers, mental health crisis services personnel, or others charged with protecting the health or safety of the public if the covered entity believes in good faith that the disclosure of the information is necessary to prevent or minimize the threat of imminent exposure to such personnel in the discharge of their duties. 45 CFR 164.512(j)(1).

• Example: A 911 call center may ask screening questions of all callers, for example, their temperature, or whether they have a cough or difficulty breathing, to identify potential cases of COVID-19. To the extent that the call center may be a HIPAA covered entity, the call center is permitted to inform a police officer being dispatched to the scene of the name, address, and screening results of the persons who may be encountered so that the officer can take extra precautions or use PPE to lessen the officer's risk of exposure to COVID-19, even if the subject of the dispatch is for a non-medical situation.

• Discussion: Under this example, a 911 call center that is a covered entity should only disclose the minimum amount of information that the officer needs to take appropriate precautions to minimize the risk of exposure. Depending on the circumstances, the minimum necessary PHI may include, for example, an individual's name and the result of the screening.

Tioga County (PA) Department of Emergency Servicesis currently conducting COVID specific screening of calls for law emergency services. As data is received from the Pennsylvania Department of Health regarding identity and addresses of COVID positive individuals, that information will be provided to responding personnel. (04/16//2020)

Module 4: If you may have been exposed to COVID 19

Watch for symptoms

Reported illnesses have ranged from mild symptoms to severe illness and death for confirmed coronavirus disease 2019 (COVID-19) cases.

These symptoms may appear 2-14 days after exposure (based on the incubation period of MERS-CoV viruses).

• Fever
• Cough
• Shortness of breath

When to Seek Medical Attention

If you develop emergency warning signs for COVID-19 get medical attention immediately. Emergency warning signs include*:

• Trouble breathing
• Persistent pain or pressure in the chest
• New confusion or inability to arouse
• Bluish lips or face

*This list is not all inclusive. Please consult your medical provider for any other symptoms that are severe or concerning.

The CDC Self-Check tool is available on this webpage: file:///C:/Users/55mthomps/Documents/CDC%20Self%20Check.html

https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/index.html

Testing

IF YOU ARE A PATIENT WHO WANTS TO BE TESTED

Stay home if:

• You are feeling mostly fine

• You are worried

Stay home and call your doctor for advice if:

• You are feeling sick, but would not have sought care under normal circumstances

Call your doctor or seek medical care if:

• You feel sick and believe you have an emergency

• If you do not have a provider call your local health department or 1-877-PA-HEALTH.

If you still need help, call your local emergency department.

If you have symptoms of COVID-19 and want to get tested, try calling your state or local health department or a medical provider. While supplies of these tests are increasing, it may still be difficult to find a place to get tested.

Decisions about testing are at the discretion of state and local health departments and/or individual clinicians.

WHAT ARE THE SYMPTOMS? In combination, symptoms of the COVID-19 virus include:

• Fever

• Cough

• Shortness of breath

• Diarrhea

The symptoms may appear in as few as two days or as long as 14 days after exposure. Reported illnesses have ranged from people with little to no symptoms to people being severely ill and dying.

https://www.health.pa.gov/topics/Documents/Diseases%20and%20Conditions/COVID19%20Testing%20Factsheet.pdf

Types of Tests

Molecular tests are used to diagnose active infection (presence of MERS-CoV) in people who are thought to be infected with MERS-CoV based on their clinical symptoms and having links to places where MERS has been reported.

Serology testing is used to detect previous infection (antibodies to MERS-CoV) in people who may have been exposed to the virus. Antibodies are proteins produced by the body's immune system to attack and kill viruses, bacteria, and other microbes during infection. The presence of antibodies to MERS-CoV indicates that a person had been previously infected with the virus and developed an immune response.

https://www.cdc.gov/coronavirus/mers/lab/lab-testing.html

Module 5: Alcohol breath testing

Intoxilyzer Products

Statement from CMI in light of COVID-19

The safety of our staff and customers is a top priority. Our customer service business hours are 7:00am - 5:00pm, Monday - Friday. If guidance or instruction is needed, please call us during our business hours and you will be transferred to someone who can help.

As a reminder of best practice usage of our Intoxilyzers, before, during, and after testing, please review the following:

Hand cleanliness: In any season of heightened susceptibility, it is always advisable to follow proper hygienic procedures. Hand cleanliness is covered very well by the Centers for Disease Control (CDC) at the following link.Even with clean hands, the operator should avoid touching their face throughout the administration of the test.

The CDC also defines Everyday Preventative Actions that Can Help Fight Germs, like Flu.

Additional recommended, hygienic practices while utilizing Intoxilyzers are as follows: Before testing:

• Maintain sanitary conditions around the Intoxilyzer by wiping down the area with non-alcoholic, disinfecting wipes. (Guidelines can again be found on the CDC website.)
• Do not allow the subject to handle or touch the Intoxilyzer.
• Do not allow the subject to touch unopened mouthpieces.
• Mouthpieces should be stored in a manner that prevents the subject's exhalations from falling on them.
• A clean mouthpiece should be unwrapped just before performing the test, taking care to preserve the wrapper so that it can be used to remove the used mouthpiece after the subject has provided a sample.

During testing:

• Attach mouthpiece to the Intoxilyzer before presenting it to the subject. For handheld Intoxilyzers, ensure the subject's breath is directed away from other persons and testing supplies.
• As always, use the correct mouthpiece supplied by CMI and designed for use with the Intoxilyzer. (See SD-2, SD-5, 200, 240, 300, 400, 400PA, 500, 600, 800, 5000, 8000, 9000)
• For the Intoxilyzer 5000, 8000, and 9000, the CMI mouthpiece, 015111, with a non-return valve (which prevents suck-back), and a lip-stop (which prevents subject breath hose contact), should be utilized as it is both DOT-approved for use and provides better hygienic protection for subject and operator.

After testing:

• With handheld instruments, Intoxilyzer SD-2, SD-5, 200, 240, 300, 400, 400PA, 500, and 600, the mouthpiece can be removed without touching it by utilizing the side of a waste container. Simply hold the mouthpiece just over the lip of the container and pull back, allowing the mouthpiece to fall into the waste container. The Intoxilyzer 800 utilizes a tab on the top of the mouthpiece that can be used to eject the mouthpiece in a similar manner.
• With the Intoxilyzer 5000, 8000, and 9000, use something such as the wrapper, or better a disposable glove, to remove the mouthpiece and discard it in a waste container.
• Take care while wiping down the instrument utilizing a non-alcoholic wipe after each use, making sure to allow surfaces to dry before the next use.
• Be sure to follow CDC guidelines for hand cleanliness after administering a breath test.

CMI stands ready to assist you with your breath testing needs, whatever they may be. Be vigilant, stay safe, and call us with any questions you may have.

Phone: (866) 835-0690 Email: service@alcoholtest.com

Lifeloc Products

As the corona virus spreads through our communities and safety concerns rise; Lifeloc wants to reassure our customers that we are here to meet your needs with both our alcohol testing products as well as a wide array of online training programs. To that end we want to remind you of best practices to follow when taking a breath alcohol test:

• Regularly clean (ideally after every subject) your Lifeloc breath alcohol tester with an antimicrobial cleaner or disinfectant that does not contain alcohol.* For example bleach based.
• Use extreme caution with hand sanitizer*; this product should not be used near or by someone administering a test. Instead, follow the hand washing protocols outlined by the CDC.
• Do not allow the subject to touch the tester.
• Do not allow the subject to touch any unopened mouthpieces.
• Use a new, freshly opened mouthpiece for every test.
• Face the breath alcohol tester and subject so that they are blowing away from you.
• Take care not to touch the "wet" end of the mouthpiece even when wearing gloves. Both the EasyTab™ and L-360™ mouthpieces are designed for operator safety.
• Utilize the ejection tab on the mouthpiece to remove directly into the trash.
• Take additional cleaning precautions to your work area including sanitizing door knobs, surfaces, pens, etc

Intoximeter Products

Disinfection and operation information: https://3gxou93ihow7rltj72rrjmb1-wpengine.netdna-ssl.com/wp-content/uploads/2020/03/Infection-Control-Cleaning-and-Disinfecting-Intoximeters-Handheld-Instruments.4.pdf

Module 6: Treatment of COVID 19

There is no medically or scientifically approved treatment for COVID 19. Treatment of COVID 19 symptoms is all that is approved at this time (outside of clinical trials).

Monitor the person for worsening symptoms. Know the emergency warning signs.

• Have their healthcare provider's contact information on hand.
• If they are getting sicker, call their healthcare provider. For medical emergencies, call 911 and notify the dispatch personnel that they have or are suspected to have COVID-19.

When to Seek Medical Attention

If you develop emergency warning signs for COVID-19 get medical attention immediately. Emergency warning signs include*:

• Trouble breathing
• Persistent pain or pressure in the chest
• New confusion or inability to arouse
• Bluish lips or face

*This list is not all inclusive. Please consult your medical provider for any other symptoms that are severe or concerning.

Call 911 if you have a medical emergency: Notify the operator that you have, or think you might have, COVID-19. If possible, put on a cloth face covering before medical help arrives.

Provide symptom treatment

• Make sure the sick person drinks a lot of fluids to stay hydrated and rests at home.
• Over-the-counter medicines may help with symptoms.
• For most people, symptoms last a few days and get better after a week.

When to end home isolation (staying home)

• People with COVID-19 who have stayed home (are home isolated) can stop home isolation under the following conditions:
  • If they will not have a test to determine if they are still contagious, they can leave home after these three things have happened:
    • They have had no fever for at least 72 hours (that is three full days of no fever without the use medicine that reduces fevers)
      AND
    • other symptoms have improved (for example, when their cough or shortness of breath have improved)
      AND
    • at least 7 days have passed since their symptoms first appeared
  • If they will be tested to determine if they are still contagious, they can leave home after these three things have happened:
    • They no longer have a fever (without the use medicine that reduces fevers)
      AND
    • other symptoms have improved (for example, when their cough or shortness of breath have improved)
      AND
    • They received two negative tests in a row, 24 hours apart. Their doctor will follow CDC guidelines.

https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/care-for-someone.html

What about chloroquine, hydroxychloroquine, and other drugs

Is it safe to take ibuprofen to treat symptoms of COVID-19?

Some French doctors advise against using ibuprofen (Motrin, Advil, many generic versions) for COVID-19 symptoms based on reports of otherwise healthy people with confirmed COVID-19 who were taking an NSAID for symptom relief and developed a severe illness, especially pneumonia. These are only observations and not based on scientific studies.

The WHO initially recommended using acetaminophen instead of ibuprofen to help reduce fever and aches and pains related to this coronavirus infection, but now states that either acetaminophen or ibuprofen can be used. Rapid changes in recommendations create uncertainty. Since some doctors remain concerned about NSAIDs, it still seems prudent to choose acetaminophen first, with a total dose not exceeding 3,000 milligrams per day.

However, if you suspect or know you have COVID-19 and cannot take acetaminophen, or have taken the maximum dose and still need symptom relief, taking over-the-counter ibuprofen does not need to be specifically avoided.

Are chloroquine and hydroxychloroquine effective for treating COVID-19?

Recently, there has been considerable discussion of whether two related drugs - chloroquine and hydroxychloroquine - that have been available for decades to treat other illnesses might also be effective in treating COVID-19.

The drugs are primarily used to treat malaria and several inflammatory diseases, including systemic lupus erythematosus (lupus) and rheumatoid arthritis. No drug is perfectly safe, but these drugs are quite safe when used for just the several days they might be needed to treat COVID-19. They are also cheap, already available at our local drug stores, and relatively free of side effects.

The question, of course, is whether they are effective against the coronavirus that causes COVID-19. Are they effective in killing the virus in a laboratory dish? And are they effective in killing the virus in people? If the answer to the first question is "no," there's no point in getting an answer to the second question.

There is strong evidence that both drugs kill the COVID-19 virus in the laboratory dish. The drugs appear to work through two mechanisms. First, they make it harder for the virus to attach itself to the cell, inhibiting the virus from entering the cell and multiplying within it. Second, if the virus does manage to get inside the cell, the drugs kill it before it can multiply.

But do the drugs work in people with COVID-19? Many studies are underway to get an answer to this question, but as of March 24, 2020, only two have issued preliminary results.

One report, published in February 2020, claimed that chloroquine had been used in more than 100 patients in China who had COVID-19. The scientists stated that their results demonstrated that chloroquine is superior to the control treatment in inhibiting the worsening of pneumonia, improving lung imaging findings, eliminating the virus from the body, and shortening the duration of the disease.

These claims are exciting. However, the report provided virtually no evidence in support of the claims. First of all, this was not a randomized, double-blind controlled trial, the gold standard for research studies. Second, no evidence was presented as to how severe the pneumonia was, nor whether findings on lung x-rays or CT scans really improved. Third, although they claim the drug made the virus disappear, they didn't report what the levels of the virus were before versus after the treatment. In short, not much evidence.

Another small study was conducted by a group of scientists in southern France, a region hard hit by COVID-19. This, also, was not a randomized trial. Instead, the scientists compared 26 patients who received hydroxychloroquine to 16 who did not: after six days, the virus was gone from the body in 70% of those given the treatment, compared to only 12.5% of those who weren't. The drug appeared to be as effective in the sickest patients as in the least sick, but the study was too small to be sure about that. The study also was too small to say that people who received the treatment were protected against a prolonged illness or death.

There are many studies underway, and we should have more solid answers within a few months.

https://www.health.harvard.edu/diseases-and-conditions/treatments-for-covid-19

Module 7: After Shift Checklist

PoliceOne provided this after shift checklist to be used to help keep your family safe after your shift is done.

AFTER-SHIFT CHECKLIST

1. Empty pockets. Place in storage bins:

ꞏ Shoes

ꞏ Phone, keys, pocket items

ꞏ Dirty clothes

2. Shower, dress in clean clothes

3. Wash dirty clothes

4. Clean work gear/equipment:

ꞏ Spray bleach/cleaning solution on shoes

ꞏ Wipe down phone, keys, pocket items

ꞏ Clean equipment (*follow manufacturer guidelines)

5. Retrace steps. Wipe down anything you've touched:

ꞏ Door handles

ꞏ Gates

ꞏ Car door

ꞏ Steering wheel

ꞏ Storage bin

6. Place gear in garage/car for decontamination

7. Wash hands

https://www.policeone.com/police-products/infection-control/articles/how-can-i-protect-my-family-from-covid-19-BJNdVYcLIHfKP0sj/?utm_source=PoliceOne+Member+Newsletter&utm_campaign=4cbdc5e058-EMAIL_CAMPAIGN_2020_04_16_09_07&utm_medium=email&utm_term=0_ca044a84ea-4cbdc5e058-57882883

Module 8: Disinfecting your cell phone

We compulsively touch our cell phones hundreds of times a day, often without being conscious that we are doing so. Viruses can transfer from a surface, to our hands, to the phone, and then back to our hands or other surfaces. Phone manufacturer recommendations for disinfection are listed below.

Apple iPhones

Is it OK to use a disinfectant on my Apple product?
Using a 70 percent isopropyl alcohol wipe or Clorox Disinfecting Wipes, you may gently wipe the hard, nonporous surfaces of your Apple product, such as the display, keyboard, or other exterior surfaces. Don't use bleach. Avoid getting moisture in any opening, and don't submerge your Apple product in any cleaning agents. Don't use on fabric or leather surfaces.

https://support.apple.com/en-us/HT204172?mod=article_inline

Samsung Phones

Properly clean your Galaxy device

Before starting, make sure your device is powered down and unplugged from any power sources. Remove any covers, cases, or accessories as well.

• A lint-free, soft microfiber cleaning cloth is ideal for cleaning your device. You may also use a camera lens cleaning cloth. These are gentle and will not damage your device.

• Use a disinfectant, such as a hypochlorous acid-based solution (containing 50-80ppm) or an alcohol-based solution (containing more than 70% ethanol or isopropyl alcohol). Do not apply these liquid solutions directly to your device; they should be carefully applied to a microfiber cloth instead.

• Gently wipe the front and back of your device with the microfiber cloth. Do not apply too much pressure.

• You should avoid getting excess moisture onto your device; however, you may dampen the corner of the microfiber cloth with a small amount of disinfectant or distilled water.

• Avoid using cans of compressed air, as they may damage the surface of your device.

• Do not use spray bleach on your device.

https://www.samsung.com/ca/support/mobile-devices/clean-your-samsung-galaxy-devices/

Google phones

To disinfect your phone, including your screen, you can use ordinary household disinfecting wipes or 70% isopropyl alcohol-based wipes. Don't use wipes that have bleach.

https://support.google.com/pixelphone/answer/7533987?hl=en

1. 2. based on the building size and number of employees, alter hours of business so that the business has sufficient time to clean or to restock or both;

1. 3. install shields or other barriers at registers and check-out areas to physically separate cashiers and customers or take other measures to ensure social distancing of customers from check-out personnel, or close lines to maintain a social distance between of 6 feet between lines;

1. 4. encourage use of online ordering by providing delivery or pick-up options;

1. 5. designate a specific time for high-risk and elderly persons to use the business at least once every week if there is a continuing in-person customer-facing component;

1. 6. require all customers to wear masks while on premises, and deny entry to individuals not wearing masks, unless the business is providing medication, medical supplies, or food, in which case the business must provide alternative methods of pick-up or delivery of such goods; however, individuals who cannot wear a mask due to a medical condition (including children under the age of 2 years per CDC guidance) may enter the premises and are not required to provide documentation of such medical condition;

1. 7. in businesses with multiple check-out lines, only use every other register, or fewer. After every hour, rotate customers and employees to the previously closed registers. Clean the previously open registers and the surrounding area, including credit card machines, following each rotation;

1. 8. schedule handwashing breaks for employees at least every hour; and

1. 9. where carts and handbaskets are available for customers' use, assign an employee to wipe down carts and handbaskets before they become available to each customer entering the premises.

This Order shall take effect immediately and be enforceable as of 8:00 p.m. on April 19, 2020.

Rachel Levine, MD

Secretary of Health

Module 10: Testing

COVID-19 testing for first responders: Understanding antibody tests and immunity

Not all COVID-19 antibody tests are created equal - an important point to consider when determining who is best serving on the front lines

Apr 22, 2020

First responders are used to being "essential" and on the front lines of any disaster - natural or manmade. The current pandemic is no exception and has required organizations to pivot their policies, practices and response in an unprecedented manner.

While the rest of the nation has been ordered to stay at home or shelter in place, first responders have been told not only to keep working, but also to show up to all the homes and establishments at the highest risk.

As the national conversation turns to re-opening, testing and data-based decisions are taking center stage as the key to understanding the pandemic - and who is safe to return to work.

For first responders, the conversation and testing decisions are even more pertinent, as many have been consistently exposed and are at high risk of both suffering from and carrying the virus.

Unfortunately, much remains unknown about what testing should look like, how reliable it is, who should get it, and when.

TWO TYPES OF TESTS

There are two categories of COVID-19 tests: polymerase chain reaction (PCR) tests and antibody tests.

The PCR tests determine if someone has the infection. Clearly, if a first responder tests positive for the infection, they should follow the standard recommendations of quarantine to avoid spreading the virus to coworkers and the public.

Antibody tests do not test if someone currently has the virus, but rather for antibodies after the fact. Antibodies are typically present in the blood anywhere from a few days to a couple weeks after the body has been infected. One downside of antibody tests is that, if you test too soon after infection, there are higher rates of false negatives where the test says you do not have antibodies when, in fact, you do.

Within antibody tests, there are different types as well. Enzyme-linked immunosorbent assays (ELISA) tests detect and measure the level of antibodies in the blood. These require a blood draw and a lab for testing. Point-of-care tests, or lateral flow tests, require only a finger stick but do not test the amount of antibody present, just whether they are present, and can produce a positive, negative or borderline result, which indicates the infection was likely recent.

Not all COVID-19 antibody tests are created equal, though.

ANTIBODY TESTS: SENSITIVITY AND SPECIFICITY

The key to understanding the effectiveness of a test is looking at sensitivity and specificity. Sensitivity is the number of true positives from a test while specificity is a true negative of a test. Ideally, you would want every test to find all the true positives and all the true negatives, but that rarely happens. While most companies marketing tests have reported good sensitivity and specificity in their pre-market testing, there is evidence that - once they took their products to market and started using them on a large scale - the accuracy of the tests were much lower than initially believed.

Currently, only one antibody test has been approved by the FDA. As of April 7, 2020, the FDA has been notified by more than 70 companies that they have blood tests available for use. The FDA has allowed companies to market tests even without approval as emergency use with the caveat that companies have to continue testing and submit their findings to the FDA. Several market their products as FDA-approved, but - to date - only four have such approval.

The availability and accuracy of testing is rapidly evolving, and a good deal remains unknown - a fact that should be considered when making decisions about first responders and testing.

It's important to note that antibody tests are more likely to report false negatives early on and don't detect active cases of COVID-19. Particularly for a first responder who has just been infected, the infection could be missed.

Early data suggests that some tests, in practice, have poor sensitivity and specificity, which means it could give people a false sense of security.

QUESTIONS OF IMMUNITY

While it is assumed that people who have had the infection develop immunity based on how other viruses have behaved, enough time has not elapsed to know if this is true for the current virus, how much antibody you have to have to develop immunity, or how long the immunity lasts.

There are instances of people who have been known to have the virus, recovered, but do not test positive for antibodies. This could be a fault of the test or it is possible that not everyone produces antibodies. Antibody testing may also miss people who are immunocompromised.

While tracking of the genome of the virus suggests its evolution is slow and the eight known strains appear to act similarly, it is changing as it evolves. It is possible that not all tests can detect all strains.

Even given the unknowns, it does not mean there is not a role for antibody testing with first responders. Rather, it suggests that testing alone should not be considered the answer. People who test positive for the antibodies - if it is a true positive - may have immunity and be better suited to serve on the front lines. However, no one should become complacent and assume a positive test means they are definitely immune.

HOW TO PROCEED

The answer - as always - is to continue best practices of PPE use and cleaning. First responders have to act as though they and everyone they come in contact with has the virus, regardless of testing.

In the interim, it is important for first responders in particular to be engaged with tracking and testing as it evolves and as opportunities present themselves. And it is more important than ever for first responders to be engaged in research.

Several tracking programs are being developed at the local, regional and national levels. As an example, more than 2 million people have already signed up to report their daily symptoms through the COVID-19 Symptom Tracker.

Now is the time to focus on symptoms, track your health and connect with department leadership about making smart staffing decisions.

About the author

Sara A. Jahnke, Ph.D. is the director of the Center for Fire, Rescue and EMS Health Research at the National Development and Research Institutes. She was the principal investigator on two large-scale, DHS-funded studies of the health and readiness of the U.S. fire service and on a study on the health of women firefighters. She is a co-investigator of several studies focused on fitness, nutrition and health behaviors in firefighters. She completed her doctorate in psychology with a health emphasis at the University of Missouri - Kansas City and the American Heart Associations' Fellowship on the Epidemiology and Prevention of Cardiovascular Disease. Connect with Jahnke on LinkedIn or via email.

https://www.policeone.com/coronavirus-covid-19/articles/covid-19-testing-for-first-responders-understanding-antibody-tests-and-immunity-irIdzIto9C5evLde/?utm_source=PoliceOne+Member+Newsletter&utm_campaign=0a15d6a955-EMAIL_CAMPAIGN_2020_04_23_07_09&utm_medium=email&utm_term=0_ca044a84ea-0a15d6a955-57882883

How to decide if you should be tested or seek care

Not everyone needs to be tested for COVID-19. Here is some information that might help you make decisions about seeking medical care or testing.

• Most people have mild illness and are able to recover at home without medical care. They may not need to be tested.
• There is no treatment specifically approved for people who have COVID-19.

CDC has guidance for who should be tested, but decisions about testing are at the discretion of state and local health departments and/or individual clinicians.

• Clinicians should work with their state and local health departments to coordinate testing through public health laboratories, or work with clinical or commercial laboratories.

How to get tested

COVID-19 testing differs by location. If you have symptoms of COVID-19 and want to get tested, call your medical provider first. You can also visit your state or local health department's website to look for the latest local information on testing. While supplies of these tests are increasing, it may still be difficult to find a place to get tested.

https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/testing.html

Module 11: PA Reopening Plan

April 23, 2020

The administration will utilize a three-phase matrix to determine when counties and/or regions are ready to begin easing some restrictions on work, congregate settings, and social interactions.

The red phase, which currently applies to the whole state, has the sole purpose of minimizing the spread of COVID-19 through strict social distancing, non-life sustaining business, school closures, and building safety protocols.

Red Phase

Work & Congregate Setting Restrictions

Life Sustaining Businesses Only Congregate Care and Prison Restrictions in Place Schools (for in-person instruction) and Most Child Care Facilities Closed

Social Restrictions

Stay at Home Orders in Place Large Gatherings Prohibited Restaurants and Bars Limited to Carry-Out and Delivery Only Only Travel for Life-Sustaining Purposes Encouraged

• Reiterate and reinforce safety guidance for businesses, workers, individuals, facilities, update if necessary
• Monitor public health indicators, adjust orders and restrictions as necessary

As regions or counties move into the yellow phase, some restrictions on work and social interaction will ease while others, such as closures of schools, gyms, and other indoor recreation centers, as well as limitations around large gatherings, remain in place. For example, retail locations will be able to open with forthcoming guidance in place that is substantially similar to the worker safety and building safety order. Otherwise retail will be able to allow for curbside pickup. The purpose of this phase is to begin to power back up the economy while keeping a close eye on the public health data to ensure the spread of disease remains contained to the greatest extent possible.

Yellow Phase

Work & Congregate Setting Restrictions

Telework Must Continue Where Feasible Businesses with In-Person Operations Must Follow Business and Building Safety Orders Child Care Open with Worker and Building Safety Orders Congregate Care and Prison Restrictions in Place Schools Remain Closed for In-Person Instruction

Social Restrictions

Stay at Home Restrictions Lifted in Favor of Aggressive Mitigation Large Gatherings of More than 25 Prohibited In-Person Retail Allowable, Curbside and Delivery Preferable Indoor Recreation, Health and Wellness Facilities (such as gyms, spas), and all Entertainment (such as casinos, theaters) Remain Closed Restaurants and Bars Limited to Carry-Out and Delivery Only

• All businesses must follow CDC and DOH guidance for social distancing and cleaning
• Monitor public health indicators, adjust orders and restrictions as necessary

The green phase eases most restrictions by lifting the stay at home and business closure orders to allow the economy to strategically reopen while continuing to prioritize public health. While this phase will facilitate a return to a "new normal," it will be equally important to continue to monitor public health indicators and adjust orders and restrictions as necessary to ensure the spread of disease remains at a minimum.

Green Phase

Work & Congregate Setting Restrictions

All Businesses Must Follow CDC and PA Department of Health Guidelines

Social Restrictions

Aggressive Mitigation Orders Lifted All Individuals Must Follow CDC and PA Department of Health Guidelines

• Monitor public health indicators, adjust orders and restrictions as necessary

https://www.governor.pa.gov/process-to-reopen-pennsylvania/

Wolf's most specific criteria for a county moving from the red to yellow designation was that they report an average of fewer than 50 cases per 100,000 individuals over the course of 14 days. He said the state wouldn't allow any significant changes until May 8th.

https://whyy.org/articles/wolf-offers-clarification-on-his-new-plan-to-reopen-pa/

Construction Industry Reopening May 1

All businesses in the construction industry in the commonwealth are permitted to resume in-person operations starting Friday, May 1 - one week earlier than previously announced.

Guidance for reopening of the construction industry in Pennsylvania can be found here:

https://www.governor.pa.gov/wp-content/uploads/2020/04/20200423-Construction-Industry-Guidance.pdf

Module 12: Traffic Stops

Many departments have recently modified policies regarding routine traffic stops. In general, officers are conducting fewer stops to reduce the number of contacts with citizens. Reducing the number of traffic stops is an effective method of reducing officer exposure. Regardless, there are occasions that mandate a traffic stop.

If a traffic stop must be performed, there are steps an officer can take to reduce exposure while conducting the stop.

The following suggestions must be considered in light of department policies and legal requirements.

Procedures that may be considered to reduce exposure:

• • Follow department guidelines regarding the use of appropriate personal protective equipment (PPE) while making the stop.

• • If the driver is alone, consider approaching the vehicle on the passenger side to maintain distance.
  • Ask the driver to remain in the vehicle.
  • Ask the driver to lower the window only enough to allow for effective and clear communication.
  • Ask the driver to don a face mask if one is available.
  • If you ask the driver to produce documentation, consider options to handling the proffered documents:
    • Proof of documentation may be available via mobile terminal or by contacting dispatch.
    • Ask the driver to hold the documentation so that you have an opportunity to write down pertinent information without touching the documents.
    • Ask the driver to hold the documentation so that you can take a photograph of the documents. The photograph can then be examined rather than the documents themselves.
    • If you must handle the documents, consider the use of disposable gloves that can be doffed and discarded safely after the stop.

• • If a citation or other paperwork is generated, determine if the driver's signature is legally required on the document. If a signature is required:
    • Ask the driver to use their own pen for the signature.
    • If the driver has no pen, offer a disposable pen that the driver may keep.
    • Use a dedicated pen that can be sanitized after each use.
    • Do not offer the driver your personal pen.

Use hand sanitizer and disinfectant wipes following the stop.

COVID era traffic stops may still be hazardous. Ensure you are following all safety precautions when making the stop.